Good medicine, good business, "Written instructions crucial compliance step"


Clients cannot select, or reject, care unless it is clear of the healthcare goals for their pets.

That's it; I am finally fed up and need to take a stand.

We must provide individualized written home-care instructions for our clients on each visit.

Use the templated A-care Canine (Table 1) associated with this article to create your own system to offer homecare instructions.

Table 1. a-care canine

Make specific A-care documents for horses, dogs, cats, ferrets, birds, rabbits and all the creatures that come into your offices.

We cannot expect clients to follow home care for illness unless we provide specific instructions.

We cannot expect clients to return for follow-up unless we give them a follow-up appointment before they leave. We cannot expect them to accept and comply with preventive medicine recommendations unless we provide specific strategies.

Compliance means the same today as it did 30 years ago. It's about client education in the form of written home-care instructions.

8 Steps of Preventive Medicine

Provide written home-care instructions for each patient to ease compliance problems. Clients will select those instructions that make sense to them and comply.

Make choices easy

Clients cannot select, or reject, care unless the healthcare goals for their pets are clear.

The usual default position on home care is that they forget. Yes, most clients simply forget your instructions by the time they pull into their driveway.

Therefore, something like 85 percent of the verbal home-care instructions are in the tank before sundown.

Which means, the patient shall either get better without compliance or it gets better in spite of the forgotten instructions.

If that is the case, what was the purpose of going to the veterinarian at all? The perceived value is missing when written instructions are forgotten or not provided.

If a client fails to follow the written home-care instructions and knows it, the veterinarian can't be blamed.

For those motivated practitioners who provide written home-care instruction, the fruits are immeasurable. The notion of individualized written home-care has been a passion for decades and it frames a practice.

Here are some thoughts to make it work:

  • Clinic staff fields the questions from the client.
  • Clinic staff cannot answer questions unless they have written home-care instruction in the medical record.
  • Clinic staff cannot follow-up unless each pertinent medical issue is addressed in the medical record.
  • Clinic veterinarians cannot possibly figure out what to do if the plans are murky.
  • People who care want specific direction about follow-up care.
  • People who care can only do so if their pet's directions are in writing.
  • People who care will spend their discretionary funds when they understand what is happening.
  • The practitioner who cares puts patient-care directions in writing.
  • People who care still will forget.

For the clinician:

  • It takes confidence to put instructions in writing.
  • It takes confidence to make complex medical problems easily understood.
  • It takes a lot of reading to be confident.
  • It takes a lot of humility to follow-up on cases.
  • It takes an open mind to follow-up on cases because things do not always go the way we think they might.
  • It takes an honest veterinarian to admit that he or she sometimes forget this important task.

Here is a list of what consumer's need:

  • Give them specific instruction.
  • Present the client with written instructions.
  • Offer these instructions in the examination room, prior to presentation of the bill (the computer printout at checkout is not acceptable).
  • They need general information about a clinical situation.
  • They need specific instructions about diet (what and how much to feed).
  • Offer instructions on exercise (none, some, confined).
  • Water intake (specifically: free choice, ice, measured).
  • Medication instructions (which drugs, how much and when).
  • Prioritize your recommendations to clients. Offer your thoughts. Which recommendations are not as urgent?
  • Schedule the next appointment before they leave your hospital.
  • Emergency contact information: Give them telephone numbers and e-mail addresses.

Save money

Written home-care instructions save money by eliminating time-consuming backtracking.

Written home-care instructions improve the quality of medical care.

Written home-care instructions make money for the practice by offering better results for the current medical crisis.

Written home-care instructions with preventive care instructions provide a gentle reminder to the clinician and the client on each visit.

Dr. Riegger, dipl. ABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him at,, telephone and fax (505) 898-0407. Find him on AVMA's NOAH as the practice management moderator. Order his books "Management for Results" and "More Management for Results" by calling (505) 898-1491.

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